Which change can help reduce osmotic load and improve tolerance in an enteral feeding?

• A. Increase volume
• B. Increase concentration
• C. Use a less concentrated formula
• D. Switch to lactose-free formula

Answer: (C)

Osmotic load from an enteral feed comes from the amount of osmotically active particles delivered per unit volume. A more concentrated formula has a higher osmolality, which pulls more water into the gut lumen and can worsen tolerance with symptoms like diarrhea and cramping. Using a less concentrated formula lowers osmolality per milliliter, reducing the overall osmotic burden on the intestines and improving tolerance. Simply increasing volume without changing concentration doesn’t reduce the total osmoles delivered and can even worsen tolerance by increasing the amount of solute entering the gut. Increasing concentration would raise osmotic load, while switching to lactose-free targets lactose intolerance rather than osmotic burden.